Fonck K, Kidula N, Jaoko W, Estambale B, Claeys P, Ndinya-Achola J, Kirui P, Bwayo J, Temmerman M
International Centre for Reproductive Health, University of Ghent, Belgium.
Sex Transm Infect. 2000 Feb;76(1):33-8. doi: 10.1136/sti.76.1.33.
To evaluate the validity of different algorithms for the diagnosis of gonococcal and chlamydial infections among pregnant and non-pregnant women consulting health services for vaginal discharge in Nairobi, Kenya.
Cross sectional study among 621 women with complaints of vaginal discharge in three city council clinics between April and August 1997. Women were interviewed and examined for symptoms and signs of sexually transmitted infections (STIs). Specimens were obtained for laboratory diagnosis of genital infections, HIV, and syphilis. The data were used to evaluate the Kenyan flow chart as well as several other generated algorithms.
The mean age was 24 years and 334 (54%) were pregnant. The overall prevalence rates were: 50% candidiasis, 23% trichomoniasis, 9% bacterial vaginosis, 7% gonorrhoea, 9% chlamydia, 7% syphilis, and 22% HIV. In non-pregnant women, gonococcal and chlamydial infection was significantly associated with (1) demographic and behavioural risk markers such as being single, younger than 20 years, multiple sex partners in the previous 3 months; (2) symptom fever; and (3) signs including presence of yellow or bloody vaginal discharge, cervical mucopus, cervical erythema, and friability. Among pregnant women only young age, dysuria, and fever were significantly associated with cervical infection. However, none of these variables was either sensitive or specific enough for the diagnosis of cervical infection. Several algorithms were generated and applied to the study data. The algorithm including risk markers performed slightly better than the current Kenyan algorithm.
STIs form a major problem in the Nairobi area and should be addressed accordingly. None of the tested algorithms for the treatment of vaginal discharge would constitute a marked improvement of the existing flow chart. Hence, better detection tools for the specific aetiology of vaginal discharge are urgently needed.
评估在肯尼亚内罗毕因阴道分泌物问题前往医疗服务机构咨询的孕妇和非孕妇中，不同算法诊断淋球菌和衣原体感染的有效性。
1997年4月至8月间，在三个市议会诊所对621名主诉有阴道分泌物问题的女性进行横断面研究。对这些女性进行访谈并检查性传播感染（STIs）的症状和体征。采集标本用于生殖器感染、艾滋病毒和梅毒的实验室诊断。数据用于评估肯尼亚流程图以及其他几种生成的算法。
平均年龄为24岁，334名（54%）为孕妇。总体患病率分别为：念珠菌病50%，滴虫病23%，细菌性阴道病9%，淋病7%，衣原体9%，梅毒7%，艾滋病毒22%。在非孕妇中，淋球菌和衣原体感染与以下因素显著相关：（1）人口统计学和行为风险标志物，如单身、年龄小于20岁、过去3个月有多个性伴侣；（2）症状发热；（3）体征，包括黄色或血性阴道分泌物、宫颈黏液脓性分泌物、宫颈红斑和脆性增加。在孕妇中，只有年轻、排尿困难和发热与宫颈感染显著相关。然而，这些变量对于宫颈感染的诊断既不敏感也不特异。生成了几种算法并应用于研究数据。包含风险标志物的算法表现略优于当前的肯尼亚算法。
性传播感染在内罗毕地区是一个主要问题，应相应地加以解决。所测试的用于治疗阴道分泌物的算法均未对现有流程图有显著改进。因此，迫切需要更好的针对阴道分泌物特定病因的检测工具。
